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Hypotensive ischemic optic neuropathy and peritoneal dialysis.
T L Jackson1, C K Farmer, C Kingswood
1The Sussex Eye Hospital, Brighton, United Kingdom. tjackson@r2d2c3po.freeserve.co.uk
American Journal of Ophthalmology
|September 11, 1999
Summary
Continuous ambulatory peritoneal dialysis can cause systemic hypotension, potentially leading to anterior ischemic optic neuropathy. Routine blood pressure checks may miss critical overnight drops, necessitating ambulatory monitoring.
Area of Science:
- Ophthalmology
- Nephrology
- Cardiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common renal replacement therapy.
- Systemic hypotension is a known complication of CAPD.
- Anterior ischemic optic neuropathy (AION) is a vision-threatening condition.
Observation:
- A 58-year-old male on CAPD presented with bilateral painless blurred vision and optic disc swelling.
- Routine blood pressure measurements were within normal limits.
- 24-hour ambulatory blood pressure monitoring revealed significant nocturnal hypotension.
Findings:
- The patient's hypotension during CAPD was linked to the development of AION.
- Ambulatory blood pressure monitoring identified pronounced early morning hypotension (as low as 91/41 mm Hg).
- Routine clinic BP measurements failed to detect the critical hypotensive episodes.
Implications:
- CAPD-induced hypotension should be considered in patients presenting with AION.
- 24-hour ambulatory blood pressure monitoring is crucial for diagnosing occult hypotension in this patient population.
- This case highlights the importance of comprehensive BP assessment in patients undergoing renal replacement therapy.